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Related Experiment Videos

Hepatotoxicity associated with sustained-release niacin.

T A Dalton1, R S Berry

  • 1Department of Medicine, University of Alabama School of Medicine, Birmingham.

The American Journal of Medicine
|July 1, 1992
PubMed
Summary

Sustained-release niacin, used for high cholesterol, can cause severe liver injury and other serious side effects. Patients previously tolerating crystalline niacin may experience adverse events after switching to sustained-release formulations.

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Area of Science:

  • Pharmacology
  • Hepatology
  • Cardiovascular Medicine

Background:

  • Niacin (nicotinic acid) effectively treats hyperlipidemias, managing elevated low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL).
  • Conventional crystalline niacin use is limited by flushing side effects.
  • Sustained-release (SR) niacin offers reduced flushing and convenient dosing, leading to increased utilization.

Observation:

  • A patient previously tolerating crystalline niacin was switched to a sustained-release (SR) niacin preparation.
  • Two days after the switch, the patient developed acute hypothermia, hypotension, metabolic acidosis, and severe hepatic dysfunction.

Findings:

  • While both niacin formulations can cause gastrointestinal and hepatotoxic side effects, these are more frequent and severe with SR preparations.

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  • The patient's acute illness was directly linked to the substitution of SR niacin.
  • This case highlights the potential for severe adverse events with SR niacin, even in patients with prior niacin tolerance.

    • Implications:

    • Clinicians should exercise caution when prescribing sustained-release niacin, particularly in patients with a history of niacin use.
    • Enhanced monitoring for hepatotoxicity and systemic adverse effects is crucial when initiating or switching to SR niacin formulations.
    • This case underscores the importance of considering formulation-specific risks associated with lipid-lowering therapies.